Covered Entity Details

DSH130071F St. Luke's Nampa Medical Center (Active) - information as of 4/29/2025 1:40:46 AM

Main Details

Name

St. Luke's Nampa Medical Center

Subdivision Name

SL REHAB - ADULT - ST LUKE'S NAMPA MEDICAL CENTER PHYSICAL THERAPY-NAMPA VENTANA

Type

Disproportionate Share Hospital

Rural

340B ID

DSH130071F

Medicare Provider Number

130071

Outpatient Facility Provider Number

Additional Details

Current Program Status

Active

Registration Date

4/8/2020

Participating Start Date

7/1/2020

Participating Approval Date

4/22/2020

Last Recertification Date

8/14/2024

Contacts

Authorizing Official

St. Luke's Health System, LTD
Kate Fowler, Senior VP & CFO
(208) 381-8717

Primary Contact

St. Luke's Health System, LTD
Amanda Davis, Pharmacy Business Analyst
(208) 706-1021

Addresses

Street Address

9850 W ST LUKES DR STE 216
Nampa, ID 83687

Billing Address

St. Luke's Health System, LTD
190 E Bannock
Boise, ID 83712

Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
History

Comments

Comment	Last Updated On
No records to display.

Medicaid Billing

At this site, will the covered entity bill Medicaid fee-for-service for drugs purchased at 340B prices?
No

Shipping Addresses

Shipping Address 1

St. Lukes Nampa Medical Center, LTD
Attn: Pharmacy
9850 W ST LUKES DRIVE
Nampa, ID 83687

Contract Pharmacies

Contract Detail	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Approval Date	Begin Date	Carve-In Effective Date	Termination Date	Last Updated On
No records to display.

Parent/Child

340B ID	Hierarchy	Entity Type	Name	Sub Name	Address	City	State	340B Status
DSH130071A	Child	DSH	St. Luke's Nampa Medical Center	CALDWELL UROLOGY - NAMPA MEDICAL CLINIC ST LUKES UROLOGY-NAMPA	9850 W ST LUKES DRIVE SUITE 300	Nampa	ID	Active
DSH130071AA	Child	DSH	St. Luke's Nampa Medical Center	ST LUKES CLINIC/CARDIOLOGY - NMOP SL PROCEDURAL SLICA - NAMPA	9850 W ST LUKES DR STE 180	NAMPA	ID	Active
DSH130071AB	Child	DSH	St. Luke's Nampa Medical Center	ST LUKES NAMPA MEDICAL CENTER - ST LUKES CLINIC CONGESTIVE HEART FAILURE	9850 W ST LUKES DR STE 180	NAMPA	ID	Approved
DSH130071B	Child	DSH	St. Luke's Nampa Medical Center	SL IDAHO PULMONARY - NAMPA MEDICAL CLINIC ST LUKES IDAHO PULMONARY ASSOCIATES-NAMPA	9850 W ST LUKES DRIVE SUITE 280	NAMPA	ID	Active
DSH130071C	Child	DSH	St. Luke's Nampa Medical Center	SL ORTHOPEDICS - NAMPA MEDICAL CLINIC ST LUKES ORTHOPEDICS-NAMPA VENTANA	9850 W ST LUKES DRIVE, SUITE 215	NAMPA	ID	Active
DSH130071D	Child	DSH	St. Luke's Nampa Medical Center	SL ID CARD ASSOCIATES - NAMPA MEDICAL CLINIC ST LUKES IDAHO CARDIOLOGY NAMPA	9850 W ST LUKES DRIVE SUITE 180	Nampa	ID	Active
DSH130071E	Child	DSH	St. Luke's Nampa Medical Center	SL FAMILY MEDICINE - NAMPA MEDICAL CLINIC ST LUKES FAMILY MEDICINE-NAMPA	9850 W ST LUKES DRIVE SUITE 290	Nampa	ID	Active
DSH130071F	Child	DSH	St. Luke's Nampa Medical Center	SL REHAB - ADULT - ST LUKE'S NAMPA MEDICAL CENTER PHYSICAL THERAPY-NAMPA VENTANA	9850 W ST LUKES DR STE 216	Nampa	ID	Active
DSH130071G	Child	DSH	St. Luke's Nampa Medical Center	INFUSION CENTER - ST LUKE'S NAMPA MEDICAL OFFICE PLAZA INFUSION CENTER-NAMPA	9850 W ST LUKES DR STE 160	Nampa	ID	Active
DSH130071H	Child	DSH	St. Luke's Nampa Medical Center	ST LUKE'S CLINIC MATERNAL FETAL MEDICINE - NAMPA	9850 W ST LUKES DR STE 280	Nampa	ID	Active
DSH130071J	Child	DSH	St. Luke's Nampa Medical Center	SL OBSTETRICS & GYNECOLOGY - ST LUKE'S OBSTETRICS AND GYNECOLOGY-NAMPA	9850 W ST LUKES DR STE 229	Nampa	ID	Active
DSH130071K	Child	DSH	St. Luke's Nampa Medical Center	SL SPINE CARE - ST LUKE'S NAMPA MEDICAL CENTER SPINE CARE-NAMPA	9850 W ST LUKES DR STE 215	Nampa	ID	Active
DSH130071L	Child	DSH	St. Luke's Nampa Medical Center	SL NW NEUROSURGERY ASSOC - ST LUKE'S NAMPA MEDICAL CENTER SPINE AND CRANIAL SURGERY-NAMPA	9850 W ST LUKES DR STE 215	Nampa	ID	Active
DSH130071M	Child	DSH	St. Luke's Nampa Medical Center	SL PEDIATRICS-NAMPA - ST LUKES CLINIC PEDIATRICS-NAMPA	9850 W ST LUKES DR. STE 270	NAMPA	ID	Active
DSH130071N	Child	DSH	St. Luke's Nampa Medical Center	ACUTE CARE SURGERY - ST LUKES CLINIC ACUTE CARE AND GENERAL SURGERY-NAMPA	9850 W ST LUKES DR. STE 260	NAMPA	ID	Active
DSH130071P	Child	DSH	St. Luke's Nampa Medical Center	PEDIATRIC MENTAL HEALTH - ST LUKES CLINIC CHILDRENS MENTAL HEALTH-NAMPA	9850 W ST LUKES DR STE 270	NAMPA	ID	Active
DSH130071Q	Child	DSH	St. Luke's Nampa Medical Center	ST LUKES LABORATORY - ST LUKE'S ANTICOAGULATION CLINIC NAMPA	9850 W ST LUKES DR STE 180	NAMPA	ID	Active
DSH130071R	Child	DSH	St. Luke's Nampa Medical Center	ST LUKES BEHAVIORAL HEALTH - ST LUKES CLINIC PSYCHIATRIC WELLNESS NAMPA	9850 W ST LUKES DR STE 320	NAMPA	ID	Active
DSH130071S	Child	DSH	St. Luke's Nampa Medical Center	ST LUKE'S NEPHROLOGY - ST LUKE'S CLINIC KIDNEY AND HYPERTENSION-NAMPA	9850 W ST LUKES DR STE 190	NAMPA	ID	Active
DSH130071T	Child	DSH	St. Luke's Nampa Medical Center	ST LUKE'S CLINIC - BARIATRICS AND GENERAL SURGERY-NAMPA	9850 W ST LUKES DR STE 260	NAMPA	ID	Active
DSH130071U	Child	DSH	St. Luke's Nampa Medical Center	ST LUKE'S CLINIC - CHILDRENS CARDIOLOGY NAMPA	9850 W ST LUKES DR STE 180	NAMPA	ID	Active
DSH130071V	Child	DSH	St. Luke's Nampa Medical Center	ST LUKES RESPIRATORY THERAPY - CADIOPULMONARY REHAB-NAMPA	9850 W ST LUKES DR STE 190	NAMPA	ID	Active
DSH130071W	Child	DSH	St. Luke's Nampa Medical Center	ST LUKES RESPIRATORY THERAPY - ST LUKES CLINIC PREVENTION AND WELLNESS-NAMPA	9850 W ST LUKES DR STE 190	NAMPA	ID	Active
DSH130071X	Child	DSH	St. Luke's Nampa Medical Center	ST LUKE'S RADIOLOGY DIAGNOSTIC - PERIPHERAL VASCULAR LAB	9850 W ST LUKES DR STE 180	Nampa	ID	Active
DSH130071Y	Child	DSH	St. Luke's Nampa Medical Center	ST LUKE'S CLINIC - HUMPHREYS DIABETES CENTER NAMPA	9850 W ST LUKES DR STE 327	NAMPA	ID	Active
DSH130071Z	Child	DSH	St. Luke's Nampa Medical Center	ST LUKES CLINIC/CARDIOLOGY - NMOP SLC PROCEDURAL CHILDRENS CARDIOLOGY - NAMPA	9850 W ST LUKES DR STE 180	NAMPA	ID	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	Last Recertification Date	Update	Recertification	8/23/2023 4:14:30 PM	8/14/2024 7:25:54 PM	8/14/2024 7:25 PM
Details	Last Recertification Date	Update	Recertification	9/7/2022 6:16:16 PM	8/23/2023 4:14:30 PM	8/23/2023 4:14 PM
Contacts	Authorizing Official	Update	Change Request	DiDio, Peter Vice President, Controller St. Lukes Regional Medical Center 2083811251	Fowler, Kate Senior VP & CFO St. Luke's Health System, LTD 2083818717	11/16/2022 7:10 AM
Contacts	Primary Contact	Update	Profile Change Request	Davis, Amanda Pharmacy Business Specialist St. Lukes Regional Medical Center 2087061021	Davis, Amanda Pharmacy Business Analyst St. Luke's Health System, LTD 2087061021	11/15/2022 9:54 AM
Details	Last Recertification Date	Update	Recertification	9/12/2021 10:40:26 PM	9/7/2022 6:16:16 PM	9/7/2022 6:16 PM
Details	Last Recertification Date	Update	Recertification	8/19/2020 12:33:38 PM	9/12/2021 10:40:26 PM	9/12/2021 10:40 PM
Details	Last Recertification Date	Update	Recertification		8/19/2020 12:33:38 PM	8/19/2020 12:33 PM
Details	State	Update		Approved	Active	7/1/2020 12:00 AM
Contacts	Signed By	Insert	New Registration		DiDio, Peter Vice President, Controller St. Lukes Regional Medical Center 2083811251	4/22/2020 8:59 AM
Details	340B ID	Update	New Registration		DSH130071F	4/22/2020 8:59 AM
Details	Entity Name	Update	New Registration	ST. LUKES NAMPA MEDICAL CENTER	St. Luke's Nampa Medical Center	4/22/2020 8:59 AM
Details	Entity Subname	Update	New Registration	SL REHAB - ADULT	SL REHAB - ADULT - ST LUKE'S NAMPA MEDICAL CENTER PHYSICAL THERAPY-NAMPA VENTANA	4/22/2020 8:59 AM
Dates	Participating Approval Date	Update	New Registration		4/22/2020 8:59:59 AM	4/22/2020 8:59 AM
Details	State	Update	New Registration	Pending	Approved	4/22/2020 8:59 AM
Dates	Signed By Date	Update	New Registration		4/8/2020 6:48:29 PM	4/22/2020 8:59 AM
Dates	Start Date	Update	New Registration		7/1/2020 12:00:00 AM	4/22/2020 8:59 AM
Addresses	Main Address	Insert	New Registration		9850 W ST LUKES DR STE 216 Nampa, ID 83687	4/8/2020 4:56 PM
Addresses	Billing Address	Insert	New Registration		St. Luke's Health System, LTD 190 E Bannock Boise, ID 83712	4/8/2020 4:56 PM
Addresses	Shipping Address	Insert	New Registration		St. Lukes Nampa Medical Center, LTD Attn: Pharmacy 9850 W ST LUKES DRIVE Nampa, ID 83687	4/8/2020 4:56 PM
Contacts	Primary Contact	Insert	New Registration		Davis, Amanda Pharmacy Business Specialist St. Lukes Regional Medical Center 2087061021	4/8/2020 4:56 PM
Contacts	Authorizing Official	Insert	New Registration		DiDio, Peter Vice President, Controller St. Lukes Regional Medical Center 2083811251	4/8/2020 4:56 PM
Details	Last Recertification Date	Insert	New Registration			4/8/2020 4:56 PM
Details	Grant Number	Insert	New Registration			4/8/2020 4:56 PM
Details	340B ID	Insert	New Registration			4/8/2020 4:56 PM
Details	Is Authorizing Official EHB Data	Insert	New Registration			4/8/2020 4:56 PM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			4/8/2020 4:56 PM
Details	Medicare Provider Number	Insert	New Registration		130071	4/8/2020 4:56 PM
Details	Entity Name	Insert	New Registration		ST. LUKES NAMPA MEDICAL CENTER	4/8/2020 4:56 PM
Details	Program Code	Insert	New Registration		DSH	4/8/2020 4:56 PM
Details	Entity Subname	Insert	New Registration		SL REHAB - ADULT	4/8/2020 4:56 PM
Dates	Participating Approval Date	Insert	New Registration			4/8/2020 4:56 PM
Details	State	Insert	New Registration		Pending	4/8/2020 4:56 PM
Dates	Registration Date	Insert	New Registration		4/8/2020 4:56:39 PM	4/8/2020 4:56 PM
Dates	Signed By Date	Insert	New Registration			4/8/2020 4:56 PM
Dates	Start Date	Insert	New Registration			4/8/2020 4:56 PM
Terminations	Termination Comments	Insert	New Registration			4/8/2020 4:56 PM
Terminations	Termination Date	Insert	New Registration			4/8/2020 4:56 PM
Terminations	Termination Effective Date	Insert	New Registration			4/8/2020 4:56 PM
Terminations	Termination Reason	Insert	New Registration			4/8/2020 4:56 PM